CSD 515: WK6-7

MIT candidate

Best for severe non-fluent with limited output (Broca's Aphasia)

Needs high motivation/frequency

Needs auditory comprehension

Needs self-monitoring

•We are using what is preserved to help facilitate speech
•Hierarchical approach
•Melodic Intonation Therapy
•MINIMAL FEEDBACK, not that much verbal feedback or they will be messed up

Constraint-Induced Language Therapy (CILT)

Constraint-Induced Movement Therapy
-Restraining use of less affected arm
-Repetitive training and shaping in intensive treatment over 2 weeks
->120 published studies

Principles of CILT

-Nonuse hypothesis/Forced Use
-Massed practice
-Shaping
-Behaviorally relevant treatment

Setup:
-"Materials"
-Small group of 2-3 participants with aphasia (ideal, but not necessary)
-Sets of matching cards
-Barrier
-MASS practice
-Success every time
-Provide support
•We don't want them to struggle, we want them to succeed and fade out our cues

Sequence:
John, do you have a vanilla latte?

Yes, Judy, I do have a vanilla latte. [Hands over the vanilla latte. Each person picks up a new card.]

Judy, do you have a veggie lo mein?


No, John, I don't have a veggie lo mein.

Modify Supports:
-Do/do not provide a script
-Tri-fold v. binder

Modifying Complexity

-Modify # of semantic units
-Personalize

Other Considerations:
•Model instead of explaining "rules"
•Limit feedback in favor of more repetitions (and social reinforcement)
•Patients in the same treatment may have different goals
•Consider taking data on 10 consecutive turns for each patient (rather than every turn)

Short-Term Goals

Intended target:
-noun
-noun+verb
-#+adjective+noun
-3-digit numbers

Accuracy:
-Accurate production, with self-correction
-Intelligible approximations

Level of cueing:
-With direct model
-With phonemic cue
-In chorale production -With word bank

Promoting Aphasic Communicative Effectiveness PACE

-Equal participation by clinician and patient

-Multi-modal communication

-Feedback based on communicative adequacy, not "accuracy"

-Clinician and patient take turns describing pictures (barrier task)

Core Values of (Life Participation Approach for Aphasia Approach not a specific treatment) LPAA

-Living aphasia is not just not being able to speak
-Identity, attitude, participation
-What types of opportunities am I given
•We need to continue to support them
•No BDAE and no WAB (it tests langauge abilities)
•WAB and CETI (a questionnaire)

Explicit goal to enhance life participation

All those affected by aphasia are entitled to service

Measure of success include documented life-enhancement changes

Both personal and environmental factors are targets of intervention

Emphasis on availability of services at all stages

Social Approach to Aphasia Intervention

Focuses on communication as a social act for expressing ideas, identities, values, and societal membership

Communication and psychosocial functioning are inseparable

Focuses on person with aphasia AND communicative, physical, social, and emotional environment

Engage living life with aphasia

Environmental Approach to Aphasia

SLP role is beyond PWA—to environment and family

Environment is external (physical world, social milieu, larger society) AND internal (physical, sensory, psychological...)

Focus on improving communicative environment